Validación de un método turbidimétrico para el diagnóstico de Helicobacter pylori (CerTest Turbilatex®).

Introducción: La infección por Helicobacter pylori (H.pylori) es una de las infecciones más prevalentes a nivel mundial con una prevalencia en España entre el 48.6 % y el 61.1% de la población. Existen diferentes técnicas invasivas y no invasivas para su diagnóstico. La detección de antígenos de H.pylori en heces permite el diagnóstico no invasivo de la infección por H. pylori, así como la evaluación posterior al tratamiento. Recientemente, un nuevo método turbidimétrico H.pylori CerTest Turbilatex® (Certest, Zaragoza, España) (CTT) ha sido desarrollado para la detección cuantitativa de antígenos para H.pylori en muestras de heces humanas basado en reacciones de aglutinación(antígeno-anticuerpo) in vitro.Objetivos: Calcular la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del kit diagnóstico CerTest Turbilatex® frente al Test del aliento con urea marcada con C13 (TA), técnica de referencia en el Hospital Clínico Universitario Lozano Blesa.Material y Métodos: Se trata de un estudio observacional, unicéntrico, prospectivo en el que se incluyó 100 pacientes mayores de 18 años susceptibles de presentar una infección por H. pylori ,a los que se les había realizado un test del aliento en el Área III de Zaragoza entre el 13 de enero del 2020 y el 21 de febrero del 2020, que aportaron una muestra de heces para la realización del test CerTest Turbilatex® y que no hubieran consumido inhibidores de la bomba de protones (IBPs) en los 15 días previos o antibióticos en el mes anterior.Resultados: Un 30% de los pacientes eran hombres y un 70% mujeres con una edad media de 49.96 ±14.40 años. La sensibilidad(S),especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo (VPN) del CerTest Turbilatex® fueron 63.04%, 55.55% ,54.71% y 63.82% respectivamente, unos valores subóptimos en comparación con el test del aliento siendo similares en el análisis por subgrupos. Conclusiones: El test de antígeno en heces evaluado presenta valores bajos de sensibilidad, especificidad, valor predictivo positivo por lo que no se podría recomendar su uso a gran escala tanto para el diagnóstico como erradicación de H .pylori en nuestra población. <br /

Nutritional Support in Pancreatic Diseases

This review summarizes the main pancreatic diseases from a nutritional approach. Nutrition is a cornerstone of pancreatic disease and is sometimes undervalued. An early identification of malnutrition is the first step in maintaining an adequate nutritional status in acute pancreatitis, chronic pancreatitis and pancreatic cancer. Following a proper diet is a pillar in the treatment of pancreatic diseases and, often, nutritional counseling becomes essential. In addition, some patients will require oral nutritional supplements and fat-soluble vitamins to combat certain deficiencies. Other patients will require enteral nutrition by nasoenteric tube or total parenteral nutrition in order to maintain the requirements, depending on the pathology and its consequences. Pancreatic exocrine insufficiency, defined as a significant decrease in pancreatic enzymes or bicarbonate until the digestive function is impaired, is common in pancreatic diseases and is the main cause of malnutrition. Pancreatic enzymes therapy allows for the management of these patients. Nutrition can improve the nutritional status and quality of life of these patients and may even improve life expectancy in patients with pancreatic cancer. For this reason, nutrition must maintain the importance it deserves

Comparison of the management of Helicobacter pylori infection between the older and younger European populations

Abstract The prevalence of Helicobacter pylori remains high in the older population. Specific age-related peculiarities may impact the outcomes of H. pylori treatment. The aim of the study was to evaluate the diagnostics and effectiveness of H. pylori eradication between the younger and older European populations. “European Registry on H. pylori Management (Hp-EuReg)” data from 2013 to 2022 were analyzed. Patients were divided into older (≥ 60 years) and younger (18–59 years) groups. Modified intention-to-treat (mITT) and per-protocol (PP) analysis was performed. 49,461 patients included of which 14,467 (29%) were older-aged. Concomitant medications and penicillin allergy were more frequent among the older patients. Differences between younger and older populations were observed in treatment duration in first-line treatment and in proton pump inhibitors (PPIs) doses in second-line treatment. The overall incidence of adverse events was lower in the older adults group. The overall first-line treatment mITT effectiveness was 88% in younger and 90% in the older patients (p < 0.05). The overall second-line mITT treatment effectiveness was 84% in both groups. The effectiveness of the most frequent first- and second-line triple therapies was suboptimal (< 90%) in both groups. Optimal efficacy (≥ 90%) was achieved by using bismuth and non-bismuth-based quadruple therapies. In conclusion, the approach to the diagnostics and treatment of H. pylori infection did not generally differ between younger and older patients. Main differences were reported in the concurrent medications, allergy to penicillin and adverse events both in first- and second-line treatment. Optimal effectiveness rates were mostly achieved by using bismuth and non-bismuth-based quadruple therapies. No clinically relevant differences in the effectiveness between the age groups were observed

Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management

Background: Management of Helicobacter pylori (H. pylori) infection requires co-treatment with proton pump inhibitors (PPIs) and the use of antibiotics to achieve successful eradication.Aim: To evaluate the role of dosage of PPIs and the duration of therapy in the effectiveness of H. pylori eradication treatments based on the 'European Registry on Helicobacter pylori management' (Hp-EuReg).Methods: Hp-EuReg is a multicentre, prospective, non-interventionist, international registry on the routine clinical practice of H. pylori management by European gastroenterologists. All infected adult patients were systematically registered from 2013 to 2022.Results: Overall, 36,579 patients from five countries with more than 1000 patients were analysed. Optimal (&gt;= 90%) first-line-modified intention-to-treat effectiveness was achieved with the following treatments: (1) 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed; (2) All 10-day (except 10-day standard triple therapy) and 14-day therapies with high-dose PPIs; and (3) 10-day quadruple therapies with clarithromycin-amoxicillin-bismuth, metronidazole-tetracycline-bismuth, and clarithromycin-amoxicillin-metronidazole (sequential), all with standard-dose PPIs. In first-line treatment, optimal effectiveness was obtained with high-dose PPIs in all 14-day treatments, in 10- and 14-day bismuth quadruple therapies and in 10-day sequential with standard-dose PPIs. Optimal second-line effectiveness was achieved with (1) metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10 days with standard and high-dose PPIs, respectively; and (2) levofloxacin-amoxicillin triple therapy for 14 days with high-dose PPIs. None of the 7-day therapies in both treatment lines achieved optimal effectiveness.Conclusions: We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme